98857 (2) 1486 e� wnl of S�ec7�! N
Building Permit Confirmed ❑
Not Required ❑
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR PLUMBING and/or GAS PIPING PERMIT
ll p, may-�y '7
Date--------. ...5.-------------------._. 19-?d—Permit No.-------.L.-A...O--.5.....7-------------
The undersigned hereby�.Sftc
h I� n actor of }he City of San Jose
for a permit to install plu s i a revrseside.
Exemption from requir rma for Contractor's License is hereby claimed
by undersigned: statement filed ❑
Undersigned attests that his State CCp°1N'ornie C fr t s/LiEe�urn #
is in full force and affect and proper) }Nou4os ihpn. (/
San Jose City Business License # V/ U �'
I certify that in the performance of the work for which this permit is issued I shall not employ
any person in any manner so as to violate the workmen's compensation laws of California.
OWNER iiCJ ' Lk UZ: e--
ADDRESS ///-PG Ya 22Ze-1S1-O c.JN At'Z
USE OF BUILDING I-11 ,•9&
�/
zea-ao 10.08 Sign�ed,/�r�-.rf-.Y ..------------ --..>--i-r±��
1486 Jamestown Dr d IvIveli �han on ll Plbg.
FIXTURES FIXTURES MAIN DRAIN
Water Heaters Floor Drains Size Material
Water Closets Hoppers To To Septic Tank
Bath Tubs Sand Traps RAIN WATER DRAINAGE
Showers Urinals Size Material '
Lavatories Area Drains To Curb To Main Sewer
Kitchen Sinki/ Water Leaders WATER SYSTEM
Dish,Wiishers Trailer Space Size Material
Waste Disposals Swim Pool FEES
Wash Trays Indirect Wastes Fixture Fee
Washing Machines Drywell Main Drain Fee
Water Treat. Equip. Backflow Preventer Storm Drain Fee
Sinks Survey Wafer Sys. Fee
Dental Units Gas Piping Fee
Drinking Fountains Survey
Permit Fee Z PO
TOTAL TOTAL FEE
INSPECTOR'S REPORT HOUSE GAS PIPING
partial No. Lines Outlets Size
'tough Tested and Approved
Finishes — By